HIV Medications

HIV (Human Immunodeficiency Virus) medications, also known as antiretroviral therapy (ART), are used to slow the progression of HIV infection and reduce the viral load in the body. These medications don’t cure HIV, but they can help people with HIV live healthier, longer lives and reduce the risk of transmitting the virus to others.

Classes of HIV Medications:

  1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs): These inhibit the reverse transcriptase enzyme, which is crucial for the HIV replication process.
    1. Examples: zidovudine (AZT), lamivudine (3TC), abacavir (ABC), tenofovir disoproxil fumarate (TDF), and emtricitabine (FTC).
  2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): They bind to the reverse transcriptase enzyme, inhibiting its action and thereby preventing HIV replication.
    1. Examples: nevirapine (NVP), efavirenz (EFV), and rilpivirine (RPV).
  3. Protease Inhibitors (PIs): They inhibit the protease enzyme that HIV needs to produce infectious particles.
    1. Examples: lopinavir/ritonavir (LPV/r), atazanavir (ATV), and darunavir (DRV).
  4. Integrase Strand Transfer Inhibitors (INSTIs): These inhibit the integrase enzyme, which HIV uses to integrate its viral DNA into the DNA of the host cell.
    1. Examples: raltegravir (RAL), dolutegravir (DTG), and bictegravir (BIC).
  5. Fusion Inhibitors: These prevent HIV from entering the host cells.
    1. Example: enfuvirtide (T-20).
  6. CCR5 Antagonists (or Entry Inhibitors): They block the CCR5 coreceptor on the surface of certain immune cells, preventing HIV’s entry.
    1. Example: maraviroc (MVC).
  7. Post-Attachment Inhibitors: These block HIV from entering the host cell after binding to it.
    1. Example: fostemsavir.

WHO Recommendations for Treatment: The World Health Organization (WHO) regularly updates its guidelines on the treatment of HIV.

  1. Initiation of ART: WHO recommends that ART should be initiated in all individuals with an HIV diagnosis, regardless of their CD4 cell count (earlier guidelines had different CD4 thresholds for starting treatment).
  2. First-line ART regimens: The recommended first-line ART for adults includes two NRTIs plus an NNRTI or an INSTI. The specific recommendation was for a combination of tenofovir (TDF), lamivudine (3TC), and dolutegravir (DTG).
  3. Second-line and third-line regimens: If first-line therapy fails (due to resistance or other factors), WHO provides guidelines for alternative regimens, typically involving a switch in the drug classes used.
  4. Children and Adolescents: Specific recommendations exist for children and adolescents based on age and weight, as some ART medications are not appropriate for younger patients.
  5. Pregnant and breastfeeding women: WHO provides guidelines to minimize the risk of HIV transmission to the baby while ensuring the mother’s health is maintained.